MEDICARE: LEAH J LORENTZEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1063394914
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEAH J LORENTZEN

Provider Business Mailing Address
First Line	:	2637 27TH AVE S # 248
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55406-1565
Country	:	US
Telephone Number	:	612-548-4459
Fax Number	:

Provider Business Practice Location Address
First Line	:	2637 27TH AVE S # 248
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55406-1565
Country	:	US
Telephone Number	:	612-548-4459
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOTHERAPIST
Name	:	LEAH JO LORENTZEN
Credential	:	LPCC
Telephone Number	:	612-548-4459

Provider Enumeration Date	:	07/22/2025
Last Update Date	:	01/30/2026

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